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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 06/12/2025
Date Signed: 06/12/2025 01:49:03 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2025 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20250325144144
FACILITY NAME:GLEN PARK AT GLENDALE - BOYNTON STFACILITY NUMBER:
197608505
ADMINISTRATOR:SUSAN PARKFACILITY TYPE:
740
ADDRESS:1250 BOYNTON STTELEPHONE:
(818) 246-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:98CENSUS: 64DATE:
06/12/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Susan ParkTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff are monitoring resident's visits.
Staff are not allowing resident to have visits for a reasonable amount of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Susan Park and explained the reason for the visit.

--- Staff are monitoring resident's visits.
--- Staff are not allowing resident to have visits for a reasonable amount of time.

It was alleged that facility is supervising other party’s (OP) visits and are not allowing OP to visit alone with Resident #1 (R1) and only allows thirty (30) minutes supervised. To investigate the allegation, requested documents at 11:45a.m., interviewed two (02) staff from 12:00p.m. to 12:40p.m.

(CONT. on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20250325144144
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST
FACILITY NUMBER: 197608505
VISIT DATE: 06/12/2025
NARRATIVE
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A review of Physician’s Report indicates Resident #1 (R1) has a diagnosis of dementia, is confused/disoriented, wanders and unable to leave the community unassisted, manage resources, manage medications or perform activities of daily living. During interviews with staff, all staff stated they are only acting in the best interest of R1, to protect their health and safety. Staff added in the past they have had a number of incidents involving OP, such as barricading the door to keep staff out, found nude in bed with R1, used condoms in found on the pillow, and inappropriate touching such as having R1 sit on OP’s lap and kissing on the lips. Staff also stated Adult Protective Services has an on-going investigation and recommended supervised visitations for no longer than thirty (30) minutes. Staff #1 (S1) stated resident is allowed to visit for an extended time and unsupervised so long as there is a trusted third person, such as a close family member, in the room with OP at all times.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
LIC9099 (FAS) - (06/04)
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